Sudden spinal cord injury after cervicothoracic manipulation therapy: illustrative case.

backgroundTraumatic spinal cord injury is a devastating condition resulting in significant functional impairment. It is known that spinal manipulation therapy, often used as complementary treatment for presumed muscular neck pain, may rarely precipitate spinal cord compression and injury in patients with undiagnosed cervical canal stenosis. OBSERVATIONS: The authors report the case of a 68-year-old woman who presented to the emergency department with right scapular-paravertebral pain and right upper limb paresthesia, initially attributed to muscular causes without imaging. Spinal manipulation therapy was administered in the emergency department, causing sudden bilateral lower limb sensory loss and right lower limb motor deficit. No imaging or neurosurgical consultation was undertaken until she returned the next day with progressive weakness, hypoesthesia, and burning dysesthesia. Subsequently, MRI revealed a large acute C6-7 disc extrusion with underlying chronic multilevel stenosis, requiring anterior fusion and posterior decompression. Postoperatively, she partially improved, but a partial motor deficit, lower limb hypoesthesia, and neuropathic pain persisted. LESSONS: This case highlights the importance of thorough clinical and radiological assessment prior to administering spinal manipulation in the cervical spine, particularly in patients with signs of sensory or motor dysfunction. Torticollis and muscular contractions in the limbs may be presenting signs of cervical stenosis and degenerative cervical myelopathy, thus requiring further neurological investigation before patients are considered for spinal manipulation therapy. https://thejns.org/doi/10.3171/CASE25304.